Current Build
Financial Management Work GroupMaturity Level: 2 Trial Use Compartments: Encounter, Patient, Practitioner, RelatedPerson

Detailed Descriptions for the elements in the Claim resource.

Claim
Element IdClaim
Definition

A provider issued list of services and products provided, or to be provided, to a patient which is provided to an insurer for payment recovery.

Control1..1
Claim.identifier
Element IdClaim.identifier
Definition

The business identifier for the instance: claim number, pre-determination or pre-authorization number.

NoteThis is a business identifer, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Claim.status
Element IdClaim.status
Definition

The status of the resource instance.

Control0..1
Terminology BindingFinancial Resource Status Codes (Required)
Typecode
Is Modifiertrue (Reason: This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid)
Summarytrue
Claim.type
Element IdClaim.type
Definition

The category of claim, e.g. oral, pharmacy, vision, institutional, professional.

Control0..1
Terminology BindingClaim Type Codes (Extensible)
TypeCodeableConcept
Comments

Affects which fields and value sets are used.

Claim.subType
Element IdClaim.subType
Definition

A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the CMS Bill Type.

Control0..*
Terminology BindingExample Claim SubType Codes (Example)
TypeCodeableConcept
Comments

This may contain the local bill type codes such as the US UB-04 bill type code.

Claim.use
Element IdClaim.use
Definition

A claim, a list of completed goods and services; a preauthorization, a list or proposed goods and services; or a predetermination, a set of goods and services being considered, for which insurer adjudication is sought.

Control0..1
Terminology BindingUse (Required)
Typecode
Summarytrue
Claim.patient
Element IdClaim.patient
Definition

Patient Resource.

Control0..1
TypeReference(Patient)
Claim.billablePeriod
Element IdClaim.billablePeriod
Definition

The billable period for which charges are being submitted.

Control0..1
TypePeriod
Claim.created
Element IdClaim.created
Definition

The date when this resource was created.

Control0..1
TypedateTime
Claim.enterer
Element IdClaim.enterer
Definition

Person who created the invoice/claim/pre-determination or pre-authorization.

Control0..1
TypeReference(Practitioner | PractitionerRole)
Claim.insurer
Element IdClaim.insurer
Definition

The Insurer who is target of the request.

Control0..1
TypeReference(Organization)
Claim.provider
Element IdClaim.provider
Definition

The provider which is responsible for the bill, claim pre-determination, pre-authorization.

Control0..1
TypeReference(Practitioner | PractitionerRole | Organization)
Claim.priority
Element IdClaim.priority
Definition

Immediate (STAT), best effort (NORMAL), deferred (DEFER).

Control0..1
Terminology BindingProcess Priority Codes (Example)
TypeCodeableConcept
Claim.fundsReserve
Element IdClaim.fundsReserve
Definition

In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.

Control0..1
Terminology BindingFunds Reservation Codes (Example)
TypeCodeableConcept
Claim.related
Element IdClaim.related
Definition

Other claims which are related to this claim such as prior claim versions or for related services.

Control0..*
Claim.related.claim
Element IdClaim.related.claim
Definition

Other claims which are related to this claim such as prior claim versions or for related services.

Control0..1
TypeReference(Claim)
Comments

Do we need a relationship code?

Claim.related.relationship
Element IdClaim.related.relationship
Definition

For example, prior or umbrella.

Control0..1
Terminology BindingExample Related Claim Relationship Codes (Example)
TypeCodeableConcept
Claim.related.reference
Element IdClaim.related.reference
Definition

An alternate organizational reference to the case or file to which this particular claim pertains - e.g. Property/Casualty insurer claim # or Workers Compensation case # .

Control0..1
TypeIdentifier
Claim.prescription
Element IdClaim.prescription
Definition

Prescription to support the dispensing of Pharmacy or Vision products.

Control0..1
TypeReference(MedicationRequest | VisionPrescription)
Requirements

For type=Pharmacy and Vision only.

Comments

Should we create a group to hold multiple prescriptions and add a sequence number and on the line items a link to the sequence.

Claim.originalPrescription
Element IdClaim.originalPrescription
Definition

Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products. For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.

Control0..1
TypeReference(MedicationRequest)
Comments

as above.

Claim.payee
Element IdClaim.payee
Definition

The party to be reimbursed for the services.

Control0..1
Claim.payee.type
Element IdClaim.payee.type
Definition

Type of Party to be reimbursed: Subscriber, provider, other.

Control1..1
Terminology BindingClaim Payee Type Codes (Example)
TypeCodeableConcept
Claim.payee.resource
Element IdClaim.payee.resource
Definition

organization | patient | practitioner | relatedperson.

Control0..1
Terminology BindingClaimPayeeResourceType (Extensible)
TypeCoding
Claim.payee.party
Element IdClaim.payee.party
Definition

Party to be reimbursed: Subscriber, provider, other.

Control0..1
TypeReference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)
Claim.referral
Element IdClaim.referral
Definition

The referral resource which lists the date, practitioner, reason and other supporting information.

Control0..1
TypeReference(ServiceRequest)
Claim.facility
Element IdClaim.facility
Definition

Facility where the services were provided.

Control0..1
TypeReference(Location)
Claim.careTeam
Element IdClaim.careTeam
Definition

The members of the team who provided the overall service as well as their role and whether responsible and qualifications.

Control0..*
Requirements

Role and Responsible might not be required when there is only a single provider listed.

Claim.careTeam.sequence
Element IdClaim.careTeam.sequence
Definition

Sequence of the careTeam which serves to order and provide a link.

Control1..1
TypepositiveInt
Requirements

Required to maintain order of the careTeam.

Claim.careTeam.provider
Element IdClaim.careTeam.provider
Definition

Member of the team who provided the overall service.

Control1..1
TypeReference(Practitioner | PractitionerRole | Organization)
Claim.careTeam.responsible
Element IdClaim.careTeam.responsible
Definition

The party who is billing and responsible for the claimed good or service rendered to the patient.

Control0..1
Typeboolean
Claim.careTeam.role
Element IdClaim.careTeam.role
Definition

The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

Control0..1
Terminology BindingClaim Care Team Role Codes (Example)
TypeCodeableConcept
Claim.careTeam.qualification
Element IdClaim.careTeam.qualification
Definition

The qualification which is applicable for this service.

Control0..1
Terminology BindingExample Provider Qualification Codes (Example)
TypeCodeableConcept
Claim.information
Element IdClaim.information
Definition

Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are multiple jurisdiction specific valuesets which are required.

Control0..*
Requirements

Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

Claim.information.sequence
Element IdClaim.information.sequence
Definition

Sequence of the information element which serves to provide a link.

Control1..1
TypepositiveInt
Requirements

To provide a reference link.

Claim.information.category
Element IdClaim.information.category
Definition

The general class of the information supplied: information; exception; accident, employment; onset, etc.

Control1..1
Terminology BindingClaim Information Category Codes (Example)
TypeCodeableConcept
Comments

This may contain the local bill type codes such as the US UB-04 bill type code.

Claim.information.code
Element IdClaim.information.code
Definition

System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought which may influence the adjudication.

Control0..1
Terminology BindingException Codes (Example)
TypeCodeableConcept
Comments

This may contain the local bill type codes such as the US UB-04 bill type code.

Claim.information.timing[x]
Element IdClaim.information.timing[x]
Definition

The date when or period to which this information refers.

Control0..1
Typedate|Period
[x] NoteSee Choice of Data Types for further information about how to use [x]
Claim.information.value[x]
Element IdClaim.information.value[x]
Definition

Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

Control0..1
Typeboolean|string|Quantity|Attachment|Reference(Any)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Claim.information.reason
Element IdClaim.information.reason
Definition

For example, provides the reason for: the additional stay, or missing tooth or any other situation where a reason code is required in addition to the content.

Control0..1
Terminology BindingMissing Tooth Reason Codes (Example)
TypeCodeableConcept
Claim.diagnosis
Element IdClaim.diagnosis
Definition

List of patient diagnosis for which care is sought.

Control0..*
Claim.diagnosis.sequence
Element IdClaim.diagnosis.sequence
Definition

Sequence of diagnosis which serves to provide a link.

Control1..1
TypepositiveInt
Requirements

Required to allow line items to reference the diagnoses.

Claim.diagnosis.diagnosis[x]
Element IdClaim.diagnosis.diagnosis[x]
Definition

The diagnosis.

Control1..1
Terminology BindingICD-10 Codes (Example)
TypeCodeableConcept|Reference(Condition)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Requirements

Required to adjudicate services rendered to condition presented.

Claim.diagnosis.type
Element IdClaim.diagnosis.type
Definition

The type of the Diagnosis, for example: admitting, primary, secondary, discharge.

Control0..*
Terminology BindingExample Diagnosis Type Codes (Example)
TypeCodeableConcept
Requirements

May be required to adjudicate services rendered.

Comments

Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

Claim.diagnosis.onAdmission
Element IdClaim.diagnosis.onAdmission
Definition

Indication of whether the diagnosis was present on admission to a facility.

Control0..1
Terminology BindingExample Diagnosis on Admission Codes (Example)
TypeCodeableConcept
Claim.diagnosis.packageCode
Element IdClaim.diagnosis.packageCode
Definition

The package billing code, for example DRG, based on the assigned grouping code system.

Control0..1
Terminology BindingExample Diagnosis Related Group Codes (Example)
TypeCodeableConcept
Requirements

May be required to adjudicate services rendered to the mandated grouping system.

Claim.procedure
Element IdClaim.procedure
Definition

Ordered list of patient procedures performed to support the adjudication.

Control0..*
Claim.procedure.sequence
Element IdClaim.procedure.sequence
Definition

Sequence of procedures which serves to order and provide a link.

Control1..1
TypepositiveInt
Requirements

Required to maintain order of the procudures.

Claim.procedure.date
Element IdClaim.procedure.date
Definition

Date and optionally time the procedure was performed .

Control0..1
TypedateTime
Requirements

Required to adjudicate services rendered.

Comments

SB DateTime??

Claim.procedure.procedure[x]
Element IdClaim.procedure.procedure[x]
Definition

The procedure code.

Control1..1
Terminology BindingICD-10 Procedure Codes (Example)
TypeCodeableConcept|Reference(Procedure)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Requirements

Required to adjudicate services rendered.

Claim.insurance
Element IdClaim.insurance
Definition

Financial instrument by which payment information for health care.

Control0..*
Requirements

Health care programs and insurers are significant payors of health service costs.

Claim.insurance.sequence
Element IdClaim.insurance.sequence
Definition

Sequence of coverage which serves to provide a link and convey coordination of benefit order.

Control1..1
TypepositiveInt
Requirements

To maintain order of the coverages.

Claim.insurance.focal
Element IdClaim.insurance.focal
Definition

A flag to indicate that this Coverage is the focus for adjudication. The Coverage against which the claim is to be adjudicated.

Control1..1
Typeboolean
Requirements

To identify which coverage is being adjudicated.

Claim.insurance.identifier
Element IdClaim.insurance.identifier
Definition

The business identifier for the instance: claim number, pre-determination or pre-authorization number.

NoteThis is a business identifer, not a resource identifier (see discussion)
Control0..1
TypeIdentifier
Requirements

This will be the claim number should it be necessary to create this claim in the future. This is provided so that payors may forward claims to other payors in the Coordination of Benefit for adjudication rather than the provider being required to initiate each adjudication.

Claim.insurance.coverage
Element IdClaim.insurance.coverage
Definition

Reference to the program or plan identification, underwriter or payor.

Control1..1
TypeReference(Coverage)
Requirements

Need to identify the issuer to target for processing and for coordination of benefit processing.

Claim.insurance.businessArrangement
Element IdClaim.insurance.businessArrangement
Definition

The contract number of a business agreement which describes the terms and conditions.

Control0..1
Typestring
Claim.insurance.preAuthRef
Element IdClaim.insurance.preAuthRef
Definition

A list of references from the Insurer to which these services pertain.

Control0..*
Typestring
Requirements

To provide any pre=determination or prior authorization reference.

Claim.insurance.claimResponse
Element IdClaim.insurance.claimResponse
Definition

The Coverages adjudication details.

Control0..1
TypeReference(ClaimResponse)
Requirements

Used by downstream payers to determine what balance remains and the net payable.

Claim.accident
Element IdClaim.accident
Definition

An accident which resulted in the need for healthcare services.

Control0..1
Claim.accident.date
Element IdClaim.accident.date
Definition

Date of an accident which these services are addressing.

Control1..1
Typedate
Requirements

Coverage may be dependant on accidents.

Claim.accident.type
Element IdClaim.accident.type
Definition

Type of accident: work, auto, etc.

Control0..1
Terminology BindingActIncidentCode (Extensible)
TypeCodeableConcept
Requirements

Coverage may be dependant on the type of accident.

Claim.accident.location[x]
Element IdClaim.accident.location[x]
Definition

Accident Place.

Control0..1
TypeAddress|Reference(Location)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Claim.item
Element IdClaim.item
Definition

First tier of goods and services.

Control0..*
Claim.item.sequence
Element IdClaim.item.sequence
Definition

A service line number.

Control1..1
TypepositiveInt
Claim.item.careTeamSequence
Element IdClaim.item.careTeamSequence
Definition

CareTeam applicable for this service or product line.

Control0..*
TypepositiveInt
Claim.item.diagnosisSequence
Element IdClaim.item.diagnosisSequence
Definition

Diagnosis applicable for this service or product line.

Control0..*
TypepositiveInt
Claim.item.procedureSequence
Element IdClaim.item.procedureSequence
Definition

Procedures applicable for this service or product line.

Control0..*
TypepositiveInt
Claim.item.informationSequence
Element IdClaim.item.informationSequence
Definition

Exceptions, special conditions and supporting information applicable for this service or product line.

Control0..*
TypepositiveInt
Claim.item.revenue
Element IdClaim.item.revenue
Definition

The type of revenue or cost center providing the product and/or service.

Control0..1
Terminology BindingExample Revenue Center Codes (Example)
TypeCodeableConcept
Claim.item.category
Element IdClaim.item.category
Definition

Health Care Service Type Codes to identify the classification of service or benefits.

Control0..1
Terminology BindingBenefit Category Codes (Example)
TypeCodeableConcept
Claim.item.billcode
Element IdClaim.item.billcode
Definition

If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,RxNorm,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

Control0..1
Terminology BindingUSCLS Codes (Example)
TypeCodeableConcept
Claim.item.modifier
Element IdClaim.item.modifier
Definition

Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.

Control0..*
Terminology BindingModifier type Codes (Example)
TypeCodeableConcept
Requirements

May impact on adjudication.

Claim.item.programCode
Element IdClaim.item.programCode
Definition

For programs which require reason codes for the inclusion or covering of this billed item under the program or sub-program.

Control0..*
Terminology BindingExample Program Reason Codes (Example)
TypeCodeableConcept
Claim.item.serviced[x]
Element IdClaim.item.serviced[x]
Definition

The date or dates when the service or product was supplied, performed or completed.

Control0..1
Typedate|Period
[x] NoteSee Choice of Data Types for further information about how to use [x]
Claim.item.location[x]
Element IdClaim.item.location[x]
Definition

Where the service was provided.

Control0..1
Terminology BindingExample Service Place Codes (Example)
TypeCodeableConcept|Address|Reference(Location)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Claim.item.quantity
Element IdClaim.item.quantity
Definition

The number of repetitions of a service or product.

Control0..1
TypeSimpleQuantity
Claim.item.unitPrice
Element IdClaim.item.unitPrice
Definition

If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.

Control0..1
TypeMoney
Claim.item.factor
Element IdClaim.item.factor
Definition

A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

Control0..1
Typedecimal
Requirements

If a fee is present the associated product/service code must be present.

Claim.item.net
Element IdClaim.item.net
Definition

The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.

Control0..1
TypeMoney
Requirements

If a fee is present the associated product/service code must be present.

Claim.item.udi
Element IdClaim.item.udi
Definition

List of Unique Device Identifiers associated with this line item.

Control0..*
TypeReference(Device)
Requirements

The UDI code and issuer if applicable for the supplied product.

Claim.item.bodySite
Element IdClaim.item.bodySite
Definition

Physical service site on the patient (limb, tooth, etc.).

Control0..1
Terminology BindingOral Site Codes (Example)
TypeCodeableConcept
Claim.item.subSite
Element IdClaim.item.subSite
Definition

A region or surface of the site, e.g. limb region or tooth surface(s).

Control0..*
Terminology BindingSurface Codes (Example)
TypeCodeableConcept
Claim.item.encounter
Element IdClaim.item.encounter
Definition

A billed item may include goods or services provided in multiple encounters.

Control0..*
TypeReference(Encounter)
Claim.item.detail
Element IdClaim.item.detail
Definition

Second tier of goods and services.

Control0..*
Claim.item.detail.sequence
Element IdClaim.item.detail.sequence
Definition

A service line number.

Control1..1
TypepositiveInt
Claim.item.detail.revenue
Element IdClaim.item.detail.revenue
Definition

The type of revenue or cost center providing the product and/or service.

Control0..1
Terminology BindingExample Revenue Center Codes (Example)
TypeCodeableConcept
Claim.item.detail.category
Element IdClaim.item.detail.category
Definition

Health Care Service Type Codes to identify the classification of service or benefits.

Control0..1
Terminology BindingBenefit Category Codes (Example)
TypeCodeableConcept
Claim.item.detail.billcode
Element IdClaim.item.detail.billcode
Definition

If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'.

Control0..1
Terminology BindingUSCLS Codes (Example)
TypeCodeableConcept
Claim.item.detail.modifier
Element IdClaim.item.detail.modifier
Definition

Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.

Control0..*
Terminology BindingModifier type Codes (Example)
TypeCodeableConcept
Requirements

May impact on adjudication.

Claim.item.detail.programCode
Element IdClaim.item.detail.programCode
Definition

For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.

Control0..*
Terminology BindingExample Program Reason Codes (Example)
TypeCodeableConcept
Claim.item.detail.quantity
Element IdClaim.item.detail.quantity
Definition

The number of repetitions of a service or product.

Control0..1
TypeSimpleQuantity
Claim.item.detail.unitPrice
Element IdClaim.item.detail.unitPrice
Definition

If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.

Control0..1
TypeMoney
Requirements

If a fee is present the associated product/service code must be present.

Claim.item.detail.factor
Element IdClaim.item.detail.factor
Definition

A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

Control0..1
Typedecimal
Requirements

If a fee is present the associated product/service code must be present.

Claim.item.detail.net
Element IdClaim.item.detail.net
Definition

The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.

Control0..1
TypeMoney
Requirements

If a fee is present the associated product/service code must be present.

Claim.item.detail.udi
Element IdClaim.item.detail.udi
Definition

List of Unique Device Identifiers associated with this line item.

Control0..*
TypeReference(Device)
Requirements

The UDI code and issuer if applicable for the supplied product.

Claim.item.detail.subDetail
Element IdClaim.item.detail.subDetail
Definition

Third tier of goods and services.

Control0..*
Claim.item.detail.subDetail.sequence
Element IdClaim.item.detail.subDetail.sequence
Definition

A service line number.

Control1..1
TypepositiveInt
Claim.item.detail.subDetail.revenue
Element IdClaim.item.detail.subDetail.revenue
Definition

The type of revenue or cost center providing the product and/or service.

Control0..1
Terminology BindingExample Revenue Center Codes (Example)
TypeCodeableConcept
Claim.item.detail.subDetail.category
Element IdClaim.item.detail.subDetail.category
Definition

Health Care Service Type Codes to identify the classification of service or benefits.

Control0..1
Terminology BindingBenefit Category Codes (Example)
TypeCodeableConcept
Claim.item.detail.subDetail.billcode
Element IdClaim.item.detail.subDetail.billcode
Definition

A code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI).

Control0..1
Terminology BindingUSCLS Codes (Example)
TypeCodeableConcept
Claim.item.detail.subDetail.modifier
Element IdClaim.item.detail.subDetail.modifier
Definition

Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.

Control0..*
Terminology BindingModifier type Codes (Example)
TypeCodeableConcept
Requirements

May impact on adjudication.

Claim.item.detail.subDetail.programCode
Element IdClaim.item.detail.subDetail.programCode
Definition

For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.

Control0..*
Terminology BindingExample Program Reason Codes (Example)
TypeCodeableConcept
Claim.item.detail.subDetail.quantity
Element IdClaim.item.detail.subDetail.quantity
Definition

The number of repetitions of a service or product.

Control0..1
TypeSimpleQuantity
Claim.item.detail.subDetail.unitPrice
Element IdClaim.item.detail.subDetail.unitPrice
Definition

The fee for an addittional service or product or charge.

Control0..1
TypeMoney
Requirements

If a fee is present the associated product/service code must be present.

Claim.item.detail.subDetail.factor
Element IdClaim.item.detail.subDetail.factor
Definition

A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

Control0..1
Typedecimal
Requirements

If a fee is present the associated product/service code must be present.

Claim.item.detail.subDetail.net
Element IdClaim.item.detail.subDetail.net
Definition

The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.

Control0..1
TypeMoney
Requirements

If a fee is present the associated product/service code must be present.

Claim.item.detail.subDetail.udi
Element IdClaim.item.detail.subDetail.udi
Definition

List of Unique Device Identifiers associated with this line item.

Control0..*
TypeReference(Device)
Requirements

The UDI code and issuer if applicable for the supplied product.

Claim.total
Element IdClaim.total
Definition

The total value of the claim.

Control0..1
TypeMoney